Provider Demographics
NPI:1770203341
Name:WITHEROW-MYERS, SHIANNE NICOLE (CRNA)
Entity type:Individual
Prefix:MRS
First Name:SHIANNE
Middle Name:NICOLE
Last Name:WITHEROW-MYERS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:SHIANNE
Other - Middle Name:NICOLE
Other - Last Name:WITHEROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6101 WILLOW LAKE DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-3953
Mailing Address - Country:US
Mailing Address - Phone:814-762-6454
Mailing Address - Fax:
Practice Address - Street 1:525 E MARKET ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1619
Practice Address - Country:US
Practice Address - Phone:330-375-3765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-01
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH143743367500000X
OHAPRN.CRNA.0020605367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered